20050838.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS 4
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CITY ZIP TELEPHONE
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ADDRESS
CITY
LICENSE
ZIP I TELEPHONE
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
OF USE
MIXED USE
CHANGE
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MULTIFAMILY
SIGN
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CYDS
FENCE
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CARPORT
ROCKERY
FIREALARM
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NUMBER
NUMBER
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PERMIT ',�;
NUMBER
JOB SUITElAPT$f
ADDRESS
PLAT NAME/SU BDIVI SION NO,
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approv
RW Permit R "red C3
07d
Street Use Per:,1'Requited
EXISTING PROPOSED
inspection ReqL d
Sidewalk Required
REQUIRED DEDICATION FT
underground
Wiring roquired [3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NOO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSE D
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PLANNING REVIEWED BY DATE
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CONSULTANT OCCUPANT
LOAD
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REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
FEE Description FEE
.
Plan Check 2X;1 State Surch arge ILI 6-V
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AT SOURCE LOT SLOPE0,1 VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
147).
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) S
U) 'APPLICANT. ON BEHALF OFHIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSOR
Fire Review
Plan Chk. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C TY OF
2 EDMONDS, WASNINGTW ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
NOT BE
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
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Total Amt. Due
21 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his1hor Deputy: and Foos are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in space provided.
FOR INSPECTION
WORKMEN'S CO
,!�P�NSATION INSURANCE AND RCW 18:27.
OF AILS SIGNAT E DATE
SIG I (OwNE5OFt AGENT): DATE SIGNED
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771-0220
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ATTENTION
EXT. 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW -IdECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC1116.
PINK -OWNER GOLD - ASSESSOR
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FINALTROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
DIVISION DATE 6
ENGINEERING
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PLANNING DIVISION DATE
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A.I.field inspection was conducted tr o. determine complia I nee with -a'proved plar us. Final 'appiovai.
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denotes r tha t , there are no objection's from the above s igned Department'! to the 'release of
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
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